Provider Demographics
NPI:1871023531
Name:1463 TSO PA
Entity Type:Organization
Organization Name:1463 TSO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:READE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/OD
Authorized Official - Phone:713-453-2972
Mailing Address - Street 1:4011 FM 1463
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-644-2020
Mailing Address - Fax:713-450-3609
Practice Address - Street 1:4011 FM 1463
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-644-2020
Practice Address - Fax:713-450-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty